The President's
Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) and its partners
continue to make important progress in the rapid scale-up of prevention,
treatment and care services. In the area of treatment, the Emergency Plan is
seeing important trends in the areas of: strengthening supply chain capacity;
procuring low cost, high-quality drugs; building public health infrastructure;
and supporting the development of new policies and guidelines to improve
efficiency. Within this context, we will continue to provide the highest level
of leadership to ensure that USG resources meet the people most in need.
PEPFAR, in coordination
with the Department of Health and Human Services Food and Drug
Administration's (HHS/FDA) fast track process, has fostered an
environment for dialogue among governments, innovators and generic companies.
The HHS/FDA process continues to achieve rapid results and will be critical to
ensuring a low-cost, high quality supply of drugs. Currently, there are 29
HHS/FDA approved or tentatively approved generic drugs available for purchase
by PEPFAR programs. An impressive eight of these are pediatric formulations.
Of the 29, several are fixed-dose combinations, which simplify treatment
regimes for patients and improves overall adherence. The fast track process
fostered an environment to build significant partnerships between innovator and
generic companies. A key example is the pediatric treatment initiative
announced by First Lady Laura Bush earlier this year. This partnership will
complement other PEPFAR efforts to support programs that expand treatment for
adults and children, such as support for health care capacity-building and
expedited regulatory review of drugs through HHS/FDA.
In September of 2005,
PEPFAR launched the Partnership for Supply Chain Management (fix acronym) SCMS
to help ensure that both the quality and the supply of drugs and laboratory
commodities are maintained. PEPFAR's SCMS and other partners are
building the human and institutional capacity of local partners in key supply
chain areas, such as forecasting. The SCMS also helps to avoid overstocks and
stock-outs, by using state-of-the-art software to support national
quantifications for more accurate drug procurement. The U.S. Government (USG)
is working with the World Bank and the Global Fund to Fight HIV/AIDS, TB and
Malaria to improve supply chain management across international partners and
within host nations. Further, SCMS is obtaining best prices by aggregating
orders and forming multi-year contracts with brand and generic drug
manufacturers. SCMS also supports in-country registration and importation of
essential HIV/AIDS drugs and commodities. As a result, there will be a
significant increase in the amount of ARVs procured by the U.S. Government
(USG) from FY2005 to FY2006. In FY2005, 11% of purchases in focus countries
included generic drugs. Preliminary data indicates a significant increase in
the procurement of generic drugs in PEPFAR focus countries. This data will
represent an important trend and will be included in PEPFAR's next report
to Congress (to be released at the end of January 2007.)
In addition, PEPFAR is
working with host governments to build public health infrastructure by
supporting construction, developing tiered public health laboratory networks,
training healthcare workers, integrating information systems under "the
three ones" (one national plan, one national coordinating authority, and
one national monitoring and evaluation system) and collaborative approaches to
financing and joint planning.
PEPFAR is also working
with multilateral agencies to improve efficiency by supporting the development
of new policies and guidelines: integrating TB/HIV activities; working with the
World Health Organization and governments to promote task-shifting for health
care workers at the country level; developing care guidelines and policies
addressing pain management; and increasing the use of rapid HIV tests and
provider initiated HIV testing. Further, PEPFAR is increasing its coordination
with other USG Presidential initiatives, like the President's Malaria
initiative (PMI). These trends show PEPFAR's added value to the wider
development response.
2. What are the
three biggest challenges that PEPFAR faces in building sustainable human
resources capacity in target countries and how will PEPFAR address these
challenges over the coming year?
Strengthening health
systems and human resources is a major focus of PEPFAR's capacity-building
efforts. Key challenges include: promoting task-shifting so that the
appropriate level of provider does particular tasks; training and retaining
health workers; and strengthening the health networks that support health care
workers.
The USG supports
activities in PEPFAR countries that focus on reforming restrictive policies
that prevent the use of community health workers and other task-shifting that
can enhance a nation's ability to respond to HIV/AIDS. Policy change to
support task-shifting can have the most immediate effect on increasing the
number of health workers. In Ethiopia, for example, policy change to support
task-shifting will allow trained community health workers to provide counseling
and testing and to draw blood, and thus, free up the limited supply of nurses
(one nurse for every 4,900 people) to provide clinical care.
Quality and
sustainability of HIV/AIDS prevention, care and treatment requires skilled
providers of health services, yet many PEPFAR countries lack the trained health
workers necessary to respond to the need. PEPFAR and its host country partners
support the following:
*
Building national strategies with
innovative approaches to retention, as in
*
The development and implementation
of curricula in pre-service settings and pre-service training for essential
health professionals as in nursing schools in
*
Using volunteers and twinning
relationships to rapidly expand the number of local service providers, as in
Systemic weaknesses in
areas such as health care networks and infrastructure continue to be obstacles
to build human resource capacity. PEPFAR, working with host countries,
supports national strategies to strengthen these critical systems. In FY2005
partners reported that approximately 25% of programmatic activities had
components that directly supported network development.
In order for communities to develop their own human resources and
organizational capacity, host governments' health systems and human resources
must be strengthened and sustained. Communities' ability to sustain
their leadership in fighting HIV/AIDS is a goal and a challenge for PEPFAR.
PEPFAR has invested nearly $68 million in human resource development and over
$90 million to build local organizational capacity in FY2006. In an effort to
build sustainable local health systems, the Emergency Plan has also
incorporated "graduation" language in contracts with non-indigenous
prime partners, which evaluates their success in transferring skills to their
indigenous sub-partners. This effort is aimed at increasing the number of
sub-partners who then become prime partners. PEPFAR anticipates a trend in the
increase of indigenous prime partners will directly impact long-term
sustainability.
From: ChrisCSF@aol.com
[mailto:ChrisCSF@aol.com]
Sent: Wednesday, November 08, 2006
10:48 AM
To: SchieggNS@state.gov
Cc: PughKA@state.gov
Subject: Re: Questions from ITPC
treatment report to PEPFAR
Yes, thanks again Nicole.
In a message dated 11/8/2006 10:27:44
A.M. Eastern Standard Time, SchieggNS@state.gov writes: